Aim . To study the relationship between the structural and functional left ventricular (LV) parameters and N-terminal pro-brain natriuretic peptide (NT-proBNP) and inflammatory markers in patients with type 2 diabetes (T2D) without clinical manifestations of cardiovascular diseases, as well as to evaluate the possibility of their use for early diagnosis of subclinical LV dysfunction. Material and methods . Data from 120 patients of both sexes aged 45-75 years (57,11±7,9 years) were analyzed. They were divided into three following groups: 1st — with T2D (n=47), 2nd — with prediabetes (n=20), 3rd — control (n=53). All participants underwent transthoracic echocardiography with assessment of the linear and volumetric heart dimensions, systolic and diastolic LV function. Speckle tracking echocardiography was analyzed with calculation of LV global longitudinal strain (GLS). The blood levels of NT-proBNP and inflammatory markers were determined (high-sensitivity C-reactive protein (hsCRP), fibrinogen, interleukin-6). Results . According to echocardiography, patients with carbohydrate metabolism disorders revealed significantly higher LV mass values, LV posterior wall thickness, and relative wall thickness in comparison with the control group. Transmitral flow parameters, as well as tissue Doppler sonography, in the T2D and prediabetes groups were significantly different from those in the control group. GLS in the groups of patients with carbohydrate metabolism disorders was lower than in the control group (p=0,001). The level of NT-proBNP was significantly higher in the T2D and prediabetes groups compared to the control group, while in all three groups it did not exceed normal values (p<0,001). A higher level of NT-proBNP was associated with hypertension — odds ratio (OR) 3,64 [1,02-13,04] (p=0,005), a decrease in LV ejection fraction — OR 1,25 [1,06-1 ,47] (p=0,007), concentric hypertrophy — OR 4,84 [1,43-16,41] (p=0,011) and decreased GLS — OR 1,85 [1,62-2,06] (p=0,005), an increase in the ratio of early and late diastolic transmitral flow (E/A) — OR 0,01 [0,008-0,416] (p=0,024) and isovolumic relaxation time (IVRT) — OR 1,08 [1,03-1,14] (p=0,03). The sensitivity and specificity of NT-proBNP as a test for predicting GLS reduction <-18% were 86 and 27%, respectively. The hsCRP level, within the reference values, was significantly higher in the T2D and prediabetes groups compared to the control group (p<0,001) and demonstrated a direct linear relationship with E/A, IVRT, early diastolic deceleration time (p<0,05). A higher level of hsCRP was significantly associated with diastolic dysfunction — OR 1,16 [1,02-1,32] (p=0,023), as well as with a GLS decrease <-18% — OR 1,58 [1,12-4,65] (p=0,03). Conclusion . In patients with T2D without clinical manifestations of cardiovascular disease, the presence of concentric LV myocardial hypertrophy, LV diastolic dysfunction and decreased GLS (<-18%) is associated with higher blood levels of NT-proBNP and hsCRP. However, in all cases, the levels of biomarkers do not exceed the reference values, which does not allow their use in the early diagnosis of subclinical LV dysfunction in T2D.

Aim. To study the relationship between echocardiographic parameters of left ventricular (LV) function and carbohydrate metabolism indicators, as well as to evaluate value of speckle-tracking echocardiography (STE) in the early diagnosis of subclinical LV dysfunction in type 2 diabetes (T2D) in individuals without clinical manifestations of cardiovascular disease (CVD). Material and methods . The study included 120 people of both sexes aged 45 to 75 years. Patients were divided into three following groups: 1 — with T2D (n=53), 2 — with prediabetes (n=20), 3 — control, without carbohydrate metabolism disorders (n=47). All participants underwent transthoracic two-dimensional echocardiography with an assessment of standard systolic and diastolic parameters, as well as quantitative STE indicators. In addition, all participants underwent laboratory diagnostics of carbohydrate metabolism disorders, which included the determination of blood fasting glucose, glycated hemoglobin (HbA 1c ), insulin, and C-peptide, as well as insulin resistance index estimation. Results. In patients with T2D, in comparison with the control group, diastolic function parameters were significantly different as follows: a lower value of early to late diastolic transmitral flow velocity (E/A) ratio, the ratio of early transmitral flow velocity to early diastolic mitral annulus velocity (E/e'), mitral annular velocity (e') and higher isovolumic relaxation time (IVRT), as well as early diastolic flow deceleration time (DT). According to multivariate analysis, not only T2D, but also prediabetes was an independent predictor of diastolic dysfunction. The Simpson's LV ejection fraction was preserved in all study participants. In patients with T2D, in comparison with the control, according to STE, a decrease in global longitudinal strain (GLS), an increase in apical rotation, and also LV twist were revealed. In a multivariate regression analysis, the HbA 1c level had an inverse relationship with GLS and was an independent predictor of its decrease, and the T2D duration was a significant predictor of twisting changes, apical and basal rotation. At the same time, GLS and LV twist had a high sensitivity in determining the decrease in E/A, e'/a', e', as well as the increase in IVRT. Conclusion. In patients with T2D without CVD manifestations, sub-clinical signs of diastolic dysfunction were revealed, such as delayed LV relaxation; systolic dysfunction with preserved ejection fraction was manifested by a decrease in GLS, as well as an increase in apical rotation and LV twisting, identified by STE. The severity of asymptomatic LV systolic-diastolic dysfunction was associated with the severity of glucose metabolism disorders and T2D duration.

Aim. To study sex characteristics of cutaneous microvascular structure and function in a cohort of healthy working-age people without cardiovascular diseases.Material and methods. The study included 35 healthy men (42±4 years) and 34 women (41 ±5 years). The cardiovascular system was assessed in all patients. The microcirculatory bed of the skin was investigated by the following non-invasive methods: 1) computerized video capillaroscopy; 2) laser Doppler flowmetry; 3) photoplethysmography.Results. According to computerized video capillaroscopy in men, compared with women, there was a smaller number of both functioning capillaries (78 vs 86 capillaries/mm2, respectively (p<0,05)) and their total number (100 vs 120 capillaries/mm2, respectively (p<0,001)). Against the background of a decrease in capillary density in men, there was a higher skin interstitial hydration — 113 vs 96 gm (p<0,005) in men than in women. At the level of precapillary arterioles, where humoral tone regulation prevails. Laser Doppler flowmetry revealed lower pulse amplitude in men than in women — 0,87 vs 1,02 pf, respectively (p<0,05), which indicates a lower arterial blood inflow to exchange microvessels. Against this background, the constrictor response of precapillary arterioles to a sympathetic nervous system stimulation in men is higher than in women — 45% vs 40%, respectively (p<0,05). At the level of large arterioles, where neural tone regulation prevails, photoplethysmography revealed lower augmentation index standardized at a heart rate in men (-4,6 vs 1,7%, respectively, p<0,05), which indicates lower rigidity of muscular vessels in men.Conclusion. In working-age healthy people, sex differences are noted at all cutaneous microvascular levels, which must be taken into account when planning studies.

OBJECTIVE:To investigate structural and functional features of cutaneous microvasculature in men of working age with newly diagnosed arterial hypertension (AH).MATERIALS AND METHODS:The study included 161 apparently healthy men from 30 to 60 years, who underwent a comprehensive examination of cardiovascular system "from the heart to the capillaries". Control group (CG) included 60 normotensive men. AH group included 101 men with elevated BP.RESULTS:There is no rarefaction of the capillary bed and latent fluid retention in the interstitial space in the skin in men with AH. No data were obtained for increased endothelial, neurogenic and myogenic tone of resistive cutaneous precapillary arterioles in AH group, but a decrease in the perfusion efficiency of the endothelial and myogenic mechanisms of tissue perfusion modulation was noted.CONCLUSION:Obtained results allow making the assumption that metabolic disorders at the level of capillaries that are of a systemic nature prevail in men with the onset of AH.

ЦЕЛЬ ИССЛЕДОВАНИЯ Изучить структурно-функциональное состояние микрососудистого русла кожи в области пальца и предплечья с определением нормативных диапазонов и выявить наличие взаимосвязей между параметрами микроциркуляции и показателями центральной гемодинамики у здоровых мужчин трудоспособного возраста. МАТЕРИАЛ И МЕТОДЫ В исследование были включены 60 мужчин в возрасте от 30 до 60 лет (средний возраст 43±7,9 года), которые, по данным инструментально-лабораторных методов исследования, не имели отклонений от показателей нормы и не принимали медикаментозных средств на постоянной основе. Всем обследуемым проводили клинико-биохимический анализ крови и комплексное неинвазивное исследование органов сердечно-сосудистой системы: компьютерную видеокапилляроскопию (ВКС) в области ногтевого ложа пальцев левой кисти, лазерную допплеровскую флоуметрию (ЛДФ) на левом предплечье и подушечке ногтевой фаланги среднего пальца с функциональными (констрикторными и далататорными) тестами, ультразвуковое сканирование сердца (ЭхоКГ), брахиоцефальных и бедренных артерий, пробу с поток-зависимой вазодилатацией на правом плече и суточное мониторирование АД (СМАД) на левом плече. РЕЗУЛЬТАТЫ Определен диапазон нормативных значений изучаемых показателей структурно-функционального состояния микроциркуляторного русла в коже предплечья и пальца методами ВКС и ЛДФ. Между показателями ВКС и центральной гемодинамики по данным ЭхоКГ и СМАД взаимосвязей не установлено. Выявлены достоверные отрицательные корреляции между показателями функционального состояния резистивных артериол в коже пальца и предплечья по данным ЛДФ с массой миокарда и размерами камер сердца по данным ЭхоКГ и уровнем САД и ДАД в ночные часы. Также отмечена отрицательная корреляционная связь между показателями прироста уровня перфузии в коже предплечья при проведении дилататорной пробы с артериальной окклюзией и уровнем САД и ДАД как в дневные, так и в ночные часы. ЗАКЛЮЧЕНИЕ Выявленные нормативные параметры и сформированный протокол проведения неинвазивного исследования структурно-функционального состояния микроциркуляторного кровотока в коже у здоровых мужчин трудоспособного возраста могут быть использованы в рамках комплексного исследования сердечно-сосудистой системы человека.

Over the past century, an increase in life expectancy has been observed in Russia and in the world. According to the United Nations, by 2100, the number of centenarians worldwide will reach 25 million. Despite the annual increase in the number of super-centenarians, this age group remains poorly understood.Aim. To estimate the prevalence of cardiovascular diseases (CVD) and the main risk factors among super-centenarians in Moscow.Material and methods. According to the register of long-livers in Moscow, 82 people aged 95 to 105 were included. Participants were examined at home.The history of life and the presence of chronic diseases was collected by participant words. To assess the state of cardiovascular system, an ultrasound of the heart and main arteries was performed.Results. Conventional CVD risk factors were the exception rather than the rule among study participants (smoking — 8 patients (9,8%), alcohol abuse — 4 (4,9%), obesity — 6 (7,3%)). Dyslipidemia was relatively widespread (n=37; 45,1%), however, there were no pronounced abnormalities in the lipid profile: the maximum increase in low-density lipoproteins was 5,6 mmol/L. The most common CVDs among the participants were hypertension (n=64; 78%), coronary artery disease (n=42; 51,2%), and heart failure (n=26; 31,7%); other diseases were much less common. The most common echocardiographic changes were left atrial dilatation (n=38; 74,5%), increased left ventricular mass, thickening of left ventricular posterior wall (n=24; 48%) and interventricular septum (n=51; 100%). Diastolic and systolic heart failure were not widespread among long-livers: 16 (32%) and 2 (3,9%), respectively. Despite a rather large number of atherosclerotic plaques in the common carotid and femoral arteries, the number of hemodynamically significant plaques was low (n=3; 4,6%). An intima-media thickening up to 1,0-1,1 mm was found.Conclusion. Long-livers in Moscow are characterized by a low prevalence of traditional CVD risk factors (with the exception of hypertension) and a fairly high prevalence of atherosclerotic CVDs, which are characterized by a subclinical course.

ЦЕЛЬ ИССЛЕДОВАНИЯ Оценить особенности функционального состояния микроциркуляции в области кожи с различной структурно-функциональной организацией у мужчин с нормальным артериальным давлением (АД) в зависимости от индекса массы тела (ИМТ). МАТЕРИАЛ И МЕТОДЫ В исследование включены 43 мужчины в возрасте от 30 до 60 лет со среднесуточными значениями систолического АД (САД) ниже 130 и диастолического АД (ДАД) ниже 80 мм рт.ст. по данным суточного мониторирования АД (СМАД). Всем пациентам выполняли лазерную допплеровскую флоуметрию (ЛДФ) на предплечье и пальце с констрикторными и дилататорными функциональными тестами, лабораторные анализы крови, эхокардиографию, СМАД. В зависимости от ИМТ пациенты были разделены на три группы: в 1-ю группу вошли 15 мужчин с ИМТ <25 кг/м2, во 2-ю группу — 21 мужчина с ИМТ 25—29,99 кг/м2, в 3-ю группу — 7 мужчин с ИМТ 30—34,99 кг/м2. РЕЗУЛЬТАТЫ По данным ЛДФ при базальной перфузии с амплитудно-частотным вейвлет-анализом колебаний кровотока различий между группами не выявлено. Констрикторная реакция при дыхательной пробе также не показала достоверных различий между группами. По мере увеличения ИМТ отмечалось достоверное снижение уровня постокклюзионной реактивной гиперемии (ПОРГ) на предплечье 264, 239 и 211% (p<0,05) и на пальце 130, 110% (p<0,05) и 109% (p<0,05) в 1, 2 и 3-й группах соответственно. Уровень ПОРГ на предплечье и пальце был достоверно (p<0,05) связан с ИМТ (r= –0,33; r= –0,43 соответственно), САД (r= –0,43; r= –0,34), ДАД (r= –0,43; r= –0,39), массой миокарда левого желудочка (ММЛЖ) (r= –0,32; r= –0,35) и уровнем мочевой кислоты (r= –0,36; r= –0,41). Уровень мочевой кислоты достоверно коррелировал с констрикторной реакцией при дыхательной пробе на пальце (r=0,48; p<0,005), с ММЛЖ (r=0,45; p<0,005), САД (r=0,55; p<0,0005) и ДАД (r=0,34; p<0,05). ЗАКЛЮЧЕНИЕ По данным ЛДФ в зависимости от ИМТ у мужчин с нормотензией в состоянии покоя и при дыхательном констрикторном тесте различий в функциональном состоянии регуляторных механизмов микроциркуляции не выявлено. По мере увеличения ИМТ отмечалось снижение дилатарного резерва микроциркуляторного русла при ПОРГ.

An unhealthy diet takes the lead in the concept of cardiovascular risk factors. It contributes to the development of "alimentary-dependent" risk factors and conditions: overweight/obesity, hyperglycemia, high blood pressure and hypercholesterolemia. This leads to high cardiovascular morbidity and mortality. Many ways to rationalize and improve nutrition have been suggested. But the supremacy in prevention of cardiovascular diseases over the past decades steadily belongs to the Mediterranean diet. The history of origin, its main components, as well as the studies in which its usefulness has been proven, became the subject of this review. In addition, issues of adaptation of the Mediterranean diet to the Russian reality are submitted for discussion.

Chronic mesenteric ischemia (CMI) is a rare vascular disease. Unlike acute ischemia with a sudden onset, CMI is characterized by permanent or episodic intestinal hypoperfusion, usually due to atherosclerotic vascular lesion. Despite the high prevalence of atherosclerosis of mesenteric arteries in the general population, clinical manifestations of CMI may be absent up to the end-stage disease, which is due to the formation of extensive collateral circulation and the presence of residual fetal circulation. CMI not only worsens the quality of life, but also increases the risk of acute ischemia against the background of chronic. This problem is relevant, since the incidence and related mortality do not tend to decrease. The article presents the case report of CMI in a patient with an atypical abdominal angina. The etiopathogenesis, clinical picture, diagnosis and treatment methods are described in relation not only to the presented report, but also to literature data. This improves understanding and management strategy of this rare life-threatening pathology.

Aim. To study the relationship between telomerase activity and parameters of carbohydrate metabolism and vascular wall depending on the type 2 diabetes (T2D).Material and methods. The study included 50 patients with T2D and 139 healthy volunteers. All subjects were assessed for carbohydrate metabolism, chronic inflammation (C-reactive protein (CRP), fibrinogen), endothelial dysfunction, carotid intima-media thickness and number of atherosclerotic plaques by duplex scanning, carotid-femoral pulse wave velocity, lymphocyte telomere length and telomerase activity.Results. In T2D patients, telomerase activity was lower (p=0,039), telomeres were shorter (p=0,031) and CRP level was higher (p=0,031) than in patients without T2D. All patients were divided by telomerase activity. T2D patients with low telomerase activity had higher values of CRP (р=0,016), pulse wave velocity (р=0,010), carotid intima-media thickness (р<0,001) and number of atherosclerotic plaques (р=0,014) than in patients without T2D. There were no significant differences in high telomerase activity group. In the group of patients with/without T2D, there were independent negative relationship between telomerase activity and glycated hemoglobin (p=0,035), fasting plasma glucose (p=0,003), arterial stiffness (p=0,044) and independent positive relationship between telomerase activity and fibrinogen (p=0,027), CRP (p=0,042).Conclusion. Vascular changes, chronic inflammation and cell aging were weightier in patients with T2D. The established relationship between telomerase activity and parameters of carbohydrate metabolism, chronic inflammation and vascular stiffness may indicate the important role of telomerase activity in the development of cardiovascular diseases in T2D patients.

832 Sports cardiology: adaption or disease / Cardiac degeneration and senescence highest activity group had significantly higher NC to C ratio compared to lowest activity group (1.85±0.31vs 1.63±0.35,p=0.04) (Figure 1).Conclusions: In a middle-aged general population, we observed a greater degree of trabeculation in highly active people free from pre-existing cardiovascular disease.Our finding indicates that exercise-associated variation in LV trabeculation is not an athlete-specific phenomenon and trabeculation may be a sensitive phenotype which remodels in response to physical activity.

The heart itself ageing is characterized by structural and functional changes, determined just by older age, even in absence of cardiovascular pathology. Carbohydrate metabolism disorders, based upon the insulin resistance, are common in elderly, and worsen the processes of ageing, including the heart. Structural changes in the heart are characterized by development of concentric remodelling of the left ventricle myocardium, and functional — by diastolic function impairment, with saved systolic function. The review focuses on the influence of ageing and carbohydrate metabolism disorders on the structure and function of myocardium, and the obvious fact is discussed, that earlier screening and correction of insulin resistance and glucose metabolism disorders might prevent or delay the progression of age-related heart failure.

AIM:To study relationship between age-associated changes of heart rate variability (HRV), telomere length (TL), and lowering of insulin sensitivity (IS).MATERIAL AND METHODS:We included in this study 229 individuals aged 23‒91 years without clinical manifestations of cardiovascular and other somatic diseases. In all participants, we analyzed HRV parameters obtained at 24-hour ECG monitoring (24-h ECG) and 5 minutes ECG recordings in the supine and standing positions. Leukocyte TL was estimated on genomic DNA using real time polymerase chain reaction. Insulin sensitivity was characterized by calculation of НОМА-IR and Gutt's insulin sensitivity index (ISI).RESULTS:Elderly people with short telomeres (.

Aim. To assess the relation of age-depended changes in heart rate variability (HRV) with telomere length. With the age, even with no cardiovascular diseases (CVD), there is a decline of HRV which is an indicator of vegetative system condition. The probable mechanism for age-related decrease in HRV might be cellular ageing. One of the markers of cellular ageing is telomere length regarded as a marker of biological age.Material and methods. Totally, 229 persons of age 23-91 y.o. included, with no clinical signs of cardiovascular diseases. All participants underwent the HRV analysis by the data of Holter ECG monitoring and of short ECG recordings supine and upright position by 5 minutes. Telomere length was assessed in leucocytes on genomic desoxyribonucleic acid (DNA) with plymeraze chain reaction real time. The participants were selected to two groups: <60 y.o. and ≥60 y.o. Comparative analysis was done, of the parameters studied, in two age groups, correlational analysis of telomere length with HRV, linear regression analysis and multiple regression.Results. In the group of the older, telomere length was higher than in the younger — 9,90±0,47 units vs 9,65±0,43 units (p<0,001) with close correlation of telomere length with the age (r=-0,32, p<0,05). By the data of linear regression, telomere length is closely related with the mean value of standard deviations of all selected RR intervals for every 5 minutes of 24-hour recording (SDANN), with the power of high-frequency spectrum (HF), relation of lowerand high-frequency waves (L/H) (β=0,36, p=0,006; β=0,39, p=0,004; β=-0,32, р=0,02, resp.). In older persons, in the group of shorter telomeres there were significantly lower values of mean standard deviations for all selected R-R-intervals (SDNN) (111 (94; 126) ms vs 122 (112; 122) ms), mean-square differences between the duratons of the next sinus intervals RR (RMSSD) R-R (RMSSD) — 16 (11; 22) ms vs 22 (17; 25) ms), power of the very low frequency spectrum components (VLF) — 1176 (718; 1453) ms2 vs 1476 (850; 1763) ms2) by the data from Holter ECG, than in the group of longer telomeres (p<0,05). Differences by the shorter recordings supine and upright were not significant. Conclusion. Telomere length is related to the age-relevant HRV changes. Telomere length might be an early predictor of the ageassociated weakening of autonomous regulation of heart functioning and reflect real biological age of vegetative nervous system irrelevant to other cardiovascular risk factors.

Aim.To study the association of chronic inflammation, oxidative stress with telomere biology in people with type 2 diabetes mellitus (T2DM).Material and Methods.A total 50 patients with T2D and without cardiovascular disease (CVD) and 139 people from control group were included in the study. All subjects were measured for carbohydrate metabolism; oxidative stress (malondialdehyde (MDA)); inflammation (C-reactive protein — CRP, fibrinogen, interleukin-6); lymphocyte telomere length, telomerase activity.Results.In diabetic patients telomeres were shorter than in controls (9.59±0.54 and 9.76±0.47; p=0.031), telomerase activity was lower (0.47±0.40 and 0.62±0.36; p=0.039), inflammation (CRP, elevated fibrinogen) was higher. All patients were divided by telomere length. In T2DM group CRP was higher in patients with «short» telomeres (7.39±1.47 and 3.59±0.58 mg/L; p=0.02). There were no significant differences in the level of chronic inflammation and oxidative stress in ‘long’ telomeres group: CRP 3.59±0.58 and 3.66±0.50 mg/L (p=0.93), MDA 2.81±0.78 and 3.24±0.78 mmol/l (p=0.08). Diabetic patients in «short» telomeres group had greater chronic inflammation: CRP 7.39±1.47 and 4.03±0.62 mg/L (p=0.046), increased fibrinogen, 0.371 and 0.159 (p=0.022). All patients were divided by telomerase activity. Severity of chronic inflammation was greatest in T2DM and the «low» activity of telomerase. There were relationship between telomere length and CRP in T2DM patients (r=–0.40; p=0.004).Conclusions. Chronic inflammation and cell aging were more pronounced in patients with T2DM. However, despite diabetes, signs of chronic inflammation were minimal in patients with «long» telomeres compared to healthy people. Perhaps long telomeres protect diabetic patients from the damaging effect of chronic inflammation.

Decreased renal function is diagnosed in a great number of people aged over 60. Decreased glomerular filtrationrate varies widely within different age ranges. One of the probable mechanisms associated with the steeper decline of renal function may be a shortening in telomere length due to some chronic inflammation. The objective of this research was to study the association of renal function with telomere length and the indicators of chronic inflammation in patients without chronic kidney disease and cardiovascular diseases. The study involved 253 patients (81 men and 172 women) with the mean age of 51.5 ± 13.3 years without chronic kidney disease and cardiovascular diseases. Of the participants, 55 patients had hypertension of 1‒2 degree, 46 patients had normal parameters of renal function, and 207 participants were characterized by a mild failure in renal function. The level of albuminuria in all patients was below 30 mg/24 h. A multivariate linear regression analysis, with consideration of age- and gender-related differences, has shown a statistically significant association of albuminuria levels with telomere lengths (p = 0.023), CRP (p = 0.047), and fibrinogen (p = 0.001). No associations have been found between telomere length and inflammatory markers, on the one hand, and the levels of glomerular filtration rate, urea and creatinine, on the other hand, although the latter well correlated with age, (p < 0.001). It has been shown that albuminuria is associated with chronic inflammation and telomere length (the marker of replicative cell senescence) to a larger extent than all other renal function indicators under study. Albuminuria can be regarded as the principal target for a therapeutic approach to prevent changes in renal function and the vascular wall.